Among the many difficulties imposed upon America by the pandemic, the scourge of anti-vaccine sentiment—and the preventable deaths caused as result—ranks among the most frustrating, especially for infectious-disease doctors like me.

People who are hospitalized with COVID-19 rarely refuse therapy, but acceptance of vaccines to help prevent infection has been considerably more limited. Seventy percent of Americans have received the initial complement of vaccine injections, and many fewer have received the boosters designed to address viral variants and confer additional protection. Why are so many people resistant to this potentially lifesaving treatment?  

Some explanations are unique to our era—the awful weaponization of science in a deeply partisan political environment during the age of social media, for instance. But the concept of vaccine hesitancy is not new. Such hesitancy is, in a larger sense, a rejection of science—a phenomenon that far predates the existence of vaccines.

One of the earliest documented controversies in science denialism comes from the field of astronomy. In the third century B.C., the Greek astronomer Aristarchus of Samos proposed a heliocentric model of the universe. The idea that the Earth and planets might revolve around the sun, rather than the other way around, was shocking at the time, and Aristarchus’s theory was quickly rejected in favor of models such as those put forth by Aristotle and Ptolemy, both of whom insisted that the Earth was the center of the universe. The fact that Aristotle and Ptolemy remain better known today than Aristarchus shows the force of the rejection. It would be some 2,000 years before the notion was seriously reconsidered.   

In the 1530s, the Polish astronomer Nicolaus Copernicus developed his own heliocentric model based on astronomical observations. Copernicus is remembered today primarily for this perspective-changing discovery. But it’s worth noting that he delayed publication of his findings until 1543, the year of his death, perhaps for fear of scorn or religious objections.  

In the early 17th century, Galileo Galilei, the Italian astronomer known as the “father of modern astronomy,” recognized that explaining the celestial changes in the position of stars and sun over time required that the Earth revolve around the sun. Galileo fully and publicly supported the Copernican theory of a heliocentric universe, and condemnation from the Vatican was swift and harsh. He was tried by the Inquisition and threatened with excommunication if he did not recant. Rather than incur the wrath of the pope, he finally agreed that he was wrong. He spent the remainder of his life under house arrest. It would be another 180 years before the Church admitted that Galileo was right.

Rejections of scientific advances are found throughout the history of medicine. There have been four great advances in medicine over the past 200 years: anesthesia, antisepsis, antibiotics, and immunization. Not every advance was met with resistance. When the benefits of the advance have been obvious, there has tended to be little hesitation. Anesthesia and its cousin, analgesia, for instance, were rapidly accepted; they relieved pain, and the advantages were readily appreciated.  

Antisepsis had a stormier path to public acceptance. In the 19th century, English and Irish physicians recognized that puerperal sepsis (a dangerous infection in a mother after delivery of a baby) was likely a contagious condition that was spread from patient to patient either by the medical staff or the local environment. They suggested that improving hygiene would reduce the high rates of mortality that puerperal sepsis caused. In 1843, Oliver Wendell Holmes Sr., a physician (and one of The Atlantic’s founders), presented a paper to the Boston Society for Medical Improvement titled “The Contagiousness of Puerperal Fever.” Holmes suggested that unwashed hands among the medical and nursing staff were responsible for transmitting puerperal fever. This did not sit well with the establishment. A prestigious Philadelphia obstetrician, Charles D. Meigs, declared Holmes’s findings to be nonsense and suggested that an increased number of cases among any physician was just bad luck.  

The physician who is most frequently recognized with establishing the contagious nature of this infection is a Hungarian obstetrician, Ignaz Semmelweis.  He noted that patients in the Vienna General Hospital who were cared for by physicians had a higher incidence of postpartum sepsis than those who were cared for by midwives. Semmelweis realized that physicians performed autopsies, whereas midwives did not, and that physicians did not wash their hands or clothing before moving from an autopsy to a delivery. (It was routine for them to attend deliveries in their bloodstained clothing, having come directly from the autopsy suite.) When he suggested simple hygiene measures such as handwashing, he was derided and eventually run out of town. The medical establishment was unwilling to accept that physicians—rather than bad air or host weaknesses—were responsible for spreading infections and harming patients.

Science denialism can work in the other direction too. When antibiotics, especially penicillin, were first introduced, they were rightly appreciated as miracle drugs. In the pre-antibiotic era, the leading cause of death among children was infectious diseases. The use of antibiotics was astoundingly successful against many, but not all, childhood diseases. The downside for this enthusiasm for treatment came when patients demanded antibiotics for conditions—such as viruses—that didn’t actually necessitate them. Fifty years ago, telling a patient that they had a virus and that penicillin was therefore of no use led to disappointment, disbelief, and even arguments from patients requesting antibiotics for simple colds. Many doctors gave in because it was simpler than spending time fighting with a patient. A consequence of the more indiscriminate use of antibiotics—which represents its own mini-genre of science denialism—has been increased bacterial resistance.

But of the four great advances, none has so broadly helped humanity, or suffered more from science denialism, than immunization. Most, but not all, of the vaccines that scientists have developed since the first immunizations in the 18th century have been developed against viruses. Of all viral infections, the most feared may well have been smallpox. Over the course of the 20th century alone, an estimated 300 million people died of smallpox. Smallpox is highly contagious and spares no age group or class. Its common form has an estimated overall mortality of roughly 30 percent, but the mortality of hemorrhagic smallpox—a more severe form of the disease—approaches 100 percent. Smallpox is also wildly contagious, a characteristic that is most evident when a previously unexposed population is exposed. Smallpox was unknown in the Americas before European explorers brought cases to the New World. The disease decimated the Indigenous populations of North America and South America as a result.

The early concept of immunization to prevent smallpox may have begun more than 1,000 years ago, in China. The history is contested, but some documents show that children would be made to inhale material from a ground-up, mature smallpox lesion scraped off of the body of the infected—a level of exposure that could trigger a person’s immune response to smallpox without causing a full-blown infection. A later technique, which involved scratching the skin of an uninfected individual with material from another person’s lesion, was observed by the wife of the English ambassador to Istanbul, who then brought this procedure to Europe. She was so impressed that she had her children immunized. Subsequently, an experiment was done in which six prisoners in London were immunized. Despite exposure to smallpox, none of them became ill.

Like many advances in medicine, smallpox immunization was met with some resistance, including worry that immunization might inadvertently spread the disease to others. This was an understandable reaction; the live smallpox virus was used, and a small percentage of inoculated individuals did develop full-blown disease and die. In 1721, there was an outbreak of smallpox in Boston. The writer and clergyman Cotton Mather urged widespread immunization but had only moderate success because of resistance from the local population.  (History complicates even the views of those who embrace science: Mather was also an ardent defender of the Salem witch trials.) Years later, a well-known case of immunization resistance occurred in Philadelphia. During an outbreak of smallpox in 1736, Benjamin Franklin’s 4-year-old son, Francis, became infected and died. Francis had not been immunized despite an opportunity to do so, and Franklin said he regretted the decision for the rest of his life.   

In the generations that followed, scientists built off of these earlier methods and eventually developed a stable and widely available smallpox vaccine. The global eradication of smallpox as a result remains one of the greatest accomplishments in the history of medicine. The last case of naturally occurring smallpox was reported more than 40 years ago.

Even so, vaccine hesitancy has persisted. In America, new vaccines for other diseases have continued to prompt their own waves of skepticism and hostility. And although science denialism is not pervasive in the way it once was centuries ago, it still rears its ugly head. The arrival of the COVID-19 vaccines brought pernicious vaccine sentiments into the spotlight. The reasons for this vehemence are many. For instance, some people who might accept the efficacy of a vaccine have such a fear of injections that they simply avoid seeking medical care until absolutely necessary. But this represents a minority of those who reject the vaccines.

A more common—and more insidious—force that pushes people away from lifesaving vaccines appears to be swelling distrust in expertise, which is both a political and cultural phenomenon. Vaccine resistance can be peddled by influential people in both liberal and conservative circles, but throughout the pandemic, right-wing anti-government organizations and television personalities in particular have promoted a stew of outrageous conspiracy theories about vaccines. Run-of-the-mill misinformation remains a problem too. Some people continue to believe that the COVID-19 vaccine will infect you and make you sick—this is not the case. Finally, of course, there are concerns about known and unknown side effects from the vaccination. Like many vaccines, the COVID shots are linked to serious health effects in extremely rare circumstances; for instance, Moderna’s and Pfizer’s mRNA shots are associated with a very small risk of heart inflammation. It is virtually impossible to prove that some side effect will not ever occur. But hundreds of millions of people have safely received the COVID vaccine in the United States alone.  

Perhaps the greatest disservice to vaccination has been the fraudulent claim that childhood vaccines cause autism. This claim was originally published in an otherwise respected medical journal in the 1990s, and has since been fully retracted. (The author lost his medical license.) Nevertheless, many people still believe this and have put their children at risk for serious illness as a result.

Our advances in science over the past two centuries have truly been extraordinary, but our society still suffers from the forces that reject reason and prevent our ability to take full advantage of discoveries that protect us all. And we need to push back against those who endanger others because they see opportunities for fame or profit in spreading dangerous disinformation. Until that happens, our species will continue to understand the world around us in fits and starts—with too many people dying, even when we know how to save them.

My 6-year-old boy died in January. We lost him after a household accident, one likely brought on by a rare cerebral-swelling condition. Paramedics got his heart beating, but it was too late to save his brain. I could hold his hand, look at the small birthmark on it, comb his hair, and call out for him, but if he could hear me or feel me, he gave no sign. He had been a child in perpetual motion, but now we couldn’t get him to wiggle a finger.

My grief is profound, ragged, desperate. I cannot imagine how anything could feel worse.

But vaccine opponents on the internet, who somehow assumed that a COVID shot was responsible for my son's death, thought my family’s pain was funny. “Lol. Yay for the jab. Right? Right?” wrote one person on Twitter. “Your decision to vaccinate your son resulted in his death,” wrote another. “This is all on YOU.” “Murder in the first.”

[Read: Twitter has no answers for #DiedSuddenly]

I’m a North Carolina–based journalist who specializes in countering misinformation on social media. I know that Twitter, Facebook, and other networks amplify bad information; that their algorithms feed on anger and division; that anonymity and distance bring out the worst in some people online. And yet I had never anticipated that anyone would mock and terrorize a grieving parent. I’ve now received thousands of harassing posts. Some people emailed me at work.

For the record, my son saw some of the finest pediatric ICU doctors in the world. He was in fact vaccinated against COVID-19. None of his doctors deemed that relevant to his medical condition. They likened his death to a lightning strike.

Strangers online saw in our story a conspiracy—a cover-up of childhood fatalities caused by COVID vaccines, a ploy to protect Big Pharma.

To them, what happened to my son was not a tragedy. It was karma for suckered parents like me.

Although some abusive posts showed up on my public Facebook page, the problem started on Twitter—whose new CEO, Elon Musk, gutted the platform’s content-moderation team after taking over.

I posted my son’s obituary there because we’d started a fundraiser in his name for the arts program at his neighborhood school. Books didn’t hold his interest, but he loved drawing big, blocky Where the Wild Things Are–style creatures. The fundraiser gave us something, anything to do. Most people were kind. Many donated. But within days, anti-vaxxers hijacked the conversation, overwhelming my feed. “Billy you killed your kid man,” one person wrote.

Accompanying the obituary was a picture of him showing off his new University of North Carolina basketball jersey—No. 1, Leaky Black—before a game. He’s all arms and legs. He will only ever always be that. Cheeks like an apple. His bangs flopped over his almond-shaped eyes. “Freckles like constellations,” his obit read. He looks unpretentious, shy, and bored. Like most children his age, anything that takes more than an hour, such as a college basketball game, is too long.  

Strangers swiped the photo from Twitter and wrote vile things on it. They’d mined my tweets, especially ones where I had written about the public-health benefits of vaccination. Someone needed to make me pay for vaccinating my child, one person insinuated. Another said my other children would be next if they were vaccinated too.

I tried to push back. Please take the conspiracy theories elsewhere, I pleaded on Twitter. That made things worse, so I stopped engaging. A blogger mocked me for fleeing social media. Commenters joined in. My grief, their content. “Your one job as a parent was to protect your children,” wrote one person. “You failed miserably.”

Our family’s therapist distinguishes “clean grief” from “dirty grief.” Clean grief is pure sadness. Dirty grief is guilt and what-ifs.

I can’t fathom clean grief when you lose a healthy child so suddenly. But my doubts aren’t about vaccination. I am filled with other questions. Had we missed earlier signs of illness? But also: Did he like me? What would he have been like as a teenager? Did he ever have a crush?

At first, I kept the harassment to myself. I didn’t want my family to know. I worried that my sadness—the sadness that I owed my son—would be crowded out by anger. So I leaned into distractions: the people crammed into my living room, sitting on the floor and sifting through my records. Grubhub coupons. Friends washing our dishes. Cheesy baked spaghetti with cooking instructions taped to the foil. Better coffee than the swill I usually buy. Meg Ryan comedies. Lots of wine. Kids—mine, nephews, nieces, neighbors—everywhere. Brave bursts of laughter. Like a weird party for the worst thing that’s ever happened to me.

[Jon D. Lee: The utter familiarity of even the strangest vaccine conspiracy theories]

I also remember the ping of my phone notifications. When our friends and relatives left at night, the pings kept coming from these strange ghouls on the internet. I wished that I believed in hell so I could imagine them going there. Losing a child is a brutal reminder that nothing is fair in this world. The harassment made me feel like there was nothing good in it either.

Some of the messages may have come from bots. Others appeared to be written by real people, including a guy whose email address identified the flooring company he owned in Alaska. “You killed your own son?” he wrote in the subject line. “You’re an idiot.” Do his family and friends know that he does this for kicks?

I’m not the only parent being harassed in this way. Some of the trolls posted photos of other children, insinuating that they had died because of COVID vaccines. I feel for the grieving mothers and fathers who receive those messages.

My friends and I reported some of the worst posts to Facebook and Twitter. A few users were booted from Twitter. But in most cases, we got no response; in a few, we received tepid form messages.

“Billy, we reviewed the comment you reported and found that it doesn’t go against our Community Standards,” Facebook told me after a stranger wormed their way onto an old post from my personal page to mock me. If I was offended, I could block them, the company said. Facebook might feel conflicted about whether to censor nipples, but tormenting a bereaved parent gets a pass.

Social-media companies will have to make a choice about the kind of space they want to create. Is it a space to connect, as Facebook solemnly promised in one 2020 commercial? Or is it a space where the worst behavior imaginable is not only tolerated but amplified?

In truth, although the cruelty of these strangers shocked me, they feel distant—like cats wailing in the alley. I can shut the window and ignore them. Nothing they say or do can fill the space he still takes up. I can smell him on his favorite blue blanket. I can feel him when I squeeze the bouncy balls that he hid, like treasure, in a wooden box by his bed. I can see him in the muddy Crocs that he left behind in one of the backyard nooks he liked to hide in. His absence feels impossible. I keep waiting for him to come back.

I can imagine my son asking, with characteristic bluntness, whether the people being mean to me on social media are good guys or bad guys, like in the movies. I probably would have reassured him that none of the messages I received was really about him. They were just a reflection of some people’s desire to spread lies, and of the callous way we treat one another online. The messages don’t affect how I choose to remember my boy.

In the last picture I have of him, taken five days before we lost him, he’s getting a bad haircut at a kids’ salon. The barber’s chair looks like a miniature Batmobile, and his legs are folded up inside. He was tall for his age, as I once was. He was already pretty like his mom. In the picture, he’s watching Paw Patrol on a little monitor placed strategically in front of the chair to keep the kids straight and still. He’s old for the show, but he’s too nice or shy to say so.

In the ICU, as we prepared to say goodbye to our son, my wife borrowed a pair of scissors from the nurse. And, being careful not to lay on any tubes going into and out of him, she crawled into his bed and straightened his bangs.

Small business owners are hoping to do a roaring trade in snacks known as takjil after several tough years due to COVID.

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At his rally in Waco this weekend, Donald Trump stood at attention as a choir of jailed January 6 rioters sang an anthem of sedition, and media outlets barely blinked.

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Every Day, Every Medium

Almost 30 years after a cult leader caused a disaster in Waco, Trump rallied his own political cult—and the location cannot be a coincidence—in that same Texas city. The Waco tent revival featured the usual Trumpian cast of grifters, carnies, and misfits, including the fan favorites Mike Lindell and Ted Nugent. Most of the former president’s speech was, of course, about himself and his many grievances, and the crowd reportedly began to thin out somewhat early.

And yet, in Waco—the first rally of Trump’s 2024 campaign—Trump proved he is still capable of doing shocking things that once would have been unthinkable. As the Associated Press reported:

With a hand over his heart, Trump stood at attention when his rally opened with a song called “Justice for All” performed by a choir of people imprisoned for their roles in the Jan. 6 insurrection at the U.S. Capitol. Some footage from the insurrection was shown on big screens displayed at the rally site as the choir sang the national anthem and a recording played of Trump reciting the Pledge of Allegiance.

In other words: A former president, a man once entrusted with the Constitution’s Article II powers as our chief magistrate and the commander in chief of the most powerful military in the world, an elected official who held our survival in his hands with the codes to our nuclear arsenal, considered it an honor to be serenaded by a group of violent insurrectionists who are sitting in jail for offenses against the government and people of the United States.

Trump’s voice was not only featured on this song; he actually volunteered to provide a recording for it. I know that many people, after years of this mad-king routine, simply do not want to process anything with the words Donald Trump in it. I don’t blame you. But let’s not look away: In Waco, Trump embraced a creepy mash-up of the national anthem, “USA” chants, and his own voice, and then proceeded for some 90 minutes to make clear that he is now irrevocably all in with the seditionists, the conspiracy theorists, the “Trump or death” fanatics, the Vladimir Putin fanboys—the whole appalling lot of them.

And yet, a day later, the story of Trump standing at attention for the January 6 choir has begun to fade from coverage. How, you might wonder, is this not still on every news site, every broadcast? To be fair, the AP called it “an extraordinary display.” The New York Times called the playing of the song “a new twist.” Perhaps ironically, one of the most candid reactions came from Fox’s Brian Kilmeade, who called Trump’s use of January 6 footage at the rally “insane.” Many media outlets used a picture of Trump with his hand over his heart, as I have done here. None of that is enough.

A thought experiment might help. Imagine if, say, Barack Obama held a rally and stood at attention as a group of anti-constitutional rioters—perhaps people who had called for attacking police officers and lynching top officials of the United States—used his voice as a motif while singing from prison to honor him. You know exactly what would happen: That one moment would dominate the news cycle until the last star in the galaxy burned out. It would define Obama for the rest of his life. (If you doubt this, remember that Obama was caught on a hot mic telling then–Russian President Dmitry Medvedev that he’d have more flexibility to negotiate after the 2012 election—a completely ordinary if somewhat unwise thing to say—and we had to hear about it for years.)

But we are worn out on Trump. We’ve simply packed all of his behavior into a barrel, labeled it as generic toxic waste, and pushed it to the side, hoping that someone will take it away and bury it far from civilization.

There’s another reason, however, we’re not ringing more alarm bells. Too many people are afraid of “amplifying” Trump, including media members who still insist on treating a violent insurrectionist movement as if it’s a normal political party. I have consistently argued for amplifying every traitorous and unhinged thing Trump says, but others have their doubts: Jay Rosen, a journalism professor at NYU, cited the disinformation expert Whitney Phillips to caution me that “sunlight disinfects,” but “it can also make things grow.”

I think this was a more pressing concern in 2016, when Trump was the beneficiary of the so-called “earned media” that can result from outrageous statements and stunts. I still think focusing on Trump and holding him accountable for his statements was the right thing to do, but I agree that too often during the 2016 campaign, he got away with being ridiculous, because he was not taken seriously enough as a threat to democracy.

In 2023, however, Trump is no longer a novelty. The man is a former president and a top candidate for his old job. Merely fact-checking him or tut-tutting about his “extraordinary” behavior would, I agree, “normalize” him, so let’s not do that. Instead, both journalists and ordinary citizens should ensure that everyone knows exactly what Trump is doing and saying, in all of its fetid and vile detail.

Moments like the Waco rally should be all over the news, for three reasons.

First, Trump fatigue is real, but the personality cult around Trump avoids it by cherry-picking what Trump says and does. Putting Trump on blast isn’t going to convert new people; if anything, we learned from Trump’s COVID press conferences as president that he does a lot of damage to himself by talking too much. People in his own party tried to get him to stop doing those bizarre performances, and he finally listened to them.

Second, Trump and his minions, especially elected Republicans, are experts at pretending that things didn’t happen the way we saw them. Ask a GOP official about Trump’s offensive statements, and you’ll likely get “I didn’t see that,” “I don’t read his tweets,” “I’ll have to check into that,” and other squirts of verbal helium. Media and citizens alike should hold those elected representatives and other officeholders to account. Ask them point-blank if they support what Trump said and if they will support him as the nominee of their party.

Third, we need to confront the reality that Trump is now on track to win the nomination yet again. In 2016 and 2020, I thought we were facing the most important elections in modern American history, but that was before Trump incited an insurrection and invited every violent kook in the nation to ride to his defense. Fine, I stand corrected: 2024 is epochally important. Trump has left no doubt that he is a violent authoritarian who intends to reject any election that does not restore him to power, that he will pardon scores of criminals, and that he will never willingly leave office. This should be said every day, in every medium.

If we are to walk ourselves back into an authoritarian nightmare, let’s at least do it without any pretenses.

Related:

Trump begins a “retribution” tour. The most disturbing part of Trump’s latest rant Today’s News An armed woman shot and killed three children and three staff members at a Christian school in Nashville. Israeli Prime Minister Benjamin Netanyahu’s plans to overhaul Israel’s judiciary were put on hold after widespread protests across the country. Humza Yousaf was named the new leader of the Scottish National Party and will almost certainly be chosen as Scotland’s next leader by the Parliament tomorrow. Dispatches Up for Debate: Conor Friedersdorf’s readers reflect on the dilemmas of urban life.

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Evening Read Jon Brenneis / Getty

Sick All the Time

By Elizabeth Bruenig

Winter is over, and what a wretched one it was. There came a point in the season when everyone in our house was sick. I stood at the top of the stairs one cold morning, gazing down blearily at the pile of mail and magazines that had accumulated by the door, knowing there were dishes dumped in the sink to match and laundry heaped in the hampers as well. I thought of Henry Knighton, a medieval cleric who witnessed the Black Death’s scouring of Europe. I once read his firsthand account of the sheep and cattle that went wandering over fields where the harvest had rotted on the vine, crops and livestock returning to wilderness amid the great diminishing of human life. I now reigned over my own plagued realm, having lost this latest confrontation with nature.

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Read. Hua Hsu’s memoir, Stay True.

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Watch. The Season 4 premiere of Succession.

The episode, which aired last night on HBO, offered familiar beats but also a hint of a new direction. (And keep reading this newsletter for another reason to watch!)

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P.S.

The final season of HBO’s hit series Succession got underway last night. I am a fan of the show, but I am especially interested in how the saga of the Roy family ends, because I’m in it.

Yes, your humble correspondent landed a (very) small part in the series, as a pundit at the Roy family’s fictional ATN network. The episodes I was in had some pretty intense plot developments, but of course, I cannot share with you what happens, not least because I don’t even know myself. My part is a scripted character, but as is often the case on such a show, there’s a lot of security around the plot, and I don’t know what happened before or after I left the set. It was all great fun, and it was an honor to be able to watch some of the main cast at work. (If you think acting is easy, just spend a few days watching professionals do it.) When the season is winding down, I will write more about this fascinating experience; in the meantime, tune in and join me—well, a character sort of like me—at ATN.

— Tom

Isabel Fattal contributed to this newsletter.